Student Discount - 20% off all membership categories for Western and Fanshawe students (contact Spence, valid Student ID required, payment by cheque only)

2015 / 2016 REGISTRATION PAYMENT OPTIONS

Full Season

Sept 14/15 - June 2016

Payment: Online payment on/or before Sept 1, 2015

$735.00

Weekdays Only

Sept 14/15 - June 2016

Payment: Online payment on/or before Sept 1, 2015

$535.00

Weekends & June (Mon & Thurs)

Sept 19/15 - June 2016

Payment: Online payment on/or before Sept 1, 2015

$350.00

Spring: April-June

April 3/16 - June 2016

Payment: Online payment on/or before March 1, 2016

$250.00

MSO registration (Associate)

Swimmers not training with the Silver Dolphins

Payment: Online payment

$80.00

IMPORTANT NOTES

Completed registration should include

completed membership application form and signed waiver

payment

Membership fees are non-refundable. Any request for exceptional circumstances may be submitted to the Board, in writing, for consideration.

London Silver Dolphins reserve the right to limit the number of memberships.

For swimmers joining part way through the season, fees will be pro-rated according to date of first swim and number of swims per week.
Click on “full”, “weekday” or “weekend” and the Executive will determine the appropriate pro-rated/reduced fee. (Payment by cash or cheque.)
For January joiners, those fees are $400, $300 and $200.

FEES: WHEN DO YOU WANT TO SWIM? *

Full ($600)Weekday $450Weekend $300MSO only $30Outdoor session $60

PERSONAL INFORMATION

First Name *

Last Name *

Street Address *

City *

Province *

Postal Code *

Primary/Home Phone *

Work

Cell/Other

Email *

If you are willing to be contacted by the London /silver Dolphins Executive regarding club activities, please check this box

Date of Birth *

Gender *

Health Card Number *

Emergency Contact Name *

Emergency Contact Phone *

Payment Method *

PayPalCheque

If paying by cheque:

Payment to: London Silver Dolphins

Mail or deliver to: D. Spencer

64 Bloomfield Drive,
London, ON
N6G 1P3

WAIVER (RELEASE AND INDEMNITY AGREEMENT)

READ VERY CAREFULLY BEFORE SIGNING

I, the undersigned participant intending to be legally bound, hereby certify that I am physically fit and have not been otherwise informed by a physician. I acknowledge that I am aware of all the risks inherent in Masters Swimming (training and competition) including possible permanent disability or death, and agree to assume all of those risks. I hereby waive any and all rights to claim for loss or damage arising out of my participation in the Masters Swimming program or any activities incidental thereto against the London Silver Dolphins, the Corporation of the City of London, Swim Ontario, Masters Swimming Ontario, host facilities, meet sponsors, meet committees or any individual officiating at the meets or supervising or coaching such activity as a condition of my participation in Masters Swimming.

In consideration of the London Silver Dolphins accepting this application, I hereby release and agree to hold harmless and indemnify the directors, officers, coaches and members of the London Silver Dolphins from all claims, actions or damages without any limitations whatsoever, whether consisting of personal injury or property damage that may result in any way while attending practices or meets whether such injuries are caused by their negligence or not, assuming myself any and all responsibility and liability for same.

I acknowledge and agree that this waiver (Release and Indemnity Agreement) is binding on myself and upon my heirs, administrators, executors and assigns and I herewith again reaffirm my free and willing intent to exercise it.